Individual
JEFFREY K WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5111 CLINTON DR, KOKOMO, IN 46902-7136
(765) 457-8381
(765) 457-4443
Mailing address
5111 CLINTON DR, KOKOMO, IN 46902-7136
(765) 457-8381
(765) 457-4443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037768A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000524563
BCBS
IN
05
—
100319130E
—
IN
Enumeration date
03/19/2007
Last updated
10/24/2014
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